Coping With Death1

Running Head: Coping With Death

Coping With Death: The Right to Self Determination

By Tamara Jeffers

MGOL 260

Abstract

During my first week working in residential health care, my first patient

passed away. In this time I learned several valuable lessons that I will take with me

into my future work. I learned how to step back and allow others to make their own

choices no matter what the circumstance. I also learned to work with residents to

evaluate and review the choices they make. I learned the importance of hope; I

learned to deal with my own grief while supporting the deceased’s peers through

their time of grief; I realized the importance of creating and maintaining a

professional and personal boundary for the sake of my myself and my family. I have

learned that, because of the nature of my profession and the close bonds I create

with the residents, I will be upset at times and will have to leave work at work for

the sake and sanity of myself and my family. This was my first real experience

having to separate work and home life so that I could function appropriately at both

and not hinder my effectiveness in either position.

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Concrete Experience:

“I’m a grown man, I can do what I want,” he growled, sweat beginning to

bead on his forehead from his exertion. Reaching for his cigarettes, he lit the next

from the butt of his previous cigarette. I sat watching him on the patio. His volume

was more than his legs could fully handle, causing him years of knee problems.

From the sweat pooling around his collar, and beginning to mat his sandy brown

hair, it looked as though he had been doing backbreaking labor. The truth, though,

was his exhaustion came from simply existing. Due to his emphysema and low

sodium, his doctor had ordered him to quit smoking and consume negligible

amounts of fluids. I sat next to my patient on the patio, watching as he devoured

copious amounts of both – all the while his breathing was getting more labored and

his skin more pale. This was the time I chose to step up and be as blunt as I could.

“Are you trying to kill yourself? “ I asked; open to hear whatever he chose to

tell me. However, I was not at all prepared for the response that followed.

“Maybe I am,” he replied, meeting my gaze with his bright blue eyes.

After his near death experience months earlier, the doctor put very strict

limitations on what he could and could not do. In our facility this did not go very far.

However in my place of employment we work to promote harm-reduction

techniques and give individuals the right to fail and learn from that failure. At first

the crew was scared, and we put a restriction on him leaving the facility or

purchasing cigarettes or fluids at any stores he happened to go to. After a few

weeks of this staff-inflicted prison, he revolted.

By advocating for himself and bringing up the misuse of the recovery model,

Harold was able to have his house arrest lifted. All went well for a week and then he

began to smoke and consume far too much fluid. We continued to talk to him while
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he sat and smoked. All our talks focused on the consequences of his actions, but

that was the extent of our interactions. All seemed to be okay and the staff began

to relax a bit, thinking we may have been too quick to jump to conclusions – until he

fell unconscious on the dining room floor.

The staff became restless and more and more discontent with the progression

of events; many expressed how badly we were failing him; that we were sitting back

watching him kill himself. Another week in-and-out of the hospital and here we sat

in the backyard smoking again. His hands shook around his Gatorade as he brought

it up to his chapped lips. The sun, reflecting on the salty sheen across his face,

made him look eerily transparent.

“You are knowingly violating a doctor’s order and knowingly endangering

your life. That means that I have to fill out a suicide assessment, right?” I

rhetorically quizzed.

“I will die here and kill myself before I go back to the Oregon State Hospital,”

he wheezed defiantly. At the end of that conversation, I reiterated to him how much

I enjoyed his company and what a great man he was. I concluded the conversation

with how much I would miss him if he were to pass away. That was the last day I

saw Harold. On my second day off, Harold fell outside and quit breathing. Staff

action, and a quick response from EMT units, saved his life for the moment, but

could not save him from the inevitable. After a month of being irresponsible, his

body functions decreasing by the day, my large, but unbelievably fragile patient,

passed on into the eternal light. What followed was uproar from staff about the

recovery process along with questions as to how we would handle this grief as

professionals and support our residents in their time of sorrow.

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Observations and Reflections:

As I said earlier, our facility is governed by the philosophy that everyone has

the right to make their own choices. It is not our place to interfere with that choice,

but only to help them evaluate and slow down the process to allow analysis prior to

making their decision. Whether we believe it is the right decision or not is not taken

into account or stated to the resident.

Many of the residents believed that we had failed Harold by watching him

deteriorate and not imposing his restrictions. Several staff also echoed these

statements behind closed doors. The opposing argument surrounded an individual’s

right to personal freedom, and the ability that all people are given through God’s

gift of free will.

This clinical turmoil, partnered with our grieving process, seemed to be too

much for our facility to handle. For weeks I went home to my husband and related

to my husband how I felt about what had happened and my feelings of guilt over

not being able to convince or save Harold. In the end Harold most likely would have

passed away no matter what restrictions he did or did not follow. His condition was

too far gone for forced prevention to have been productive. Rather than living out

his life as he wanted, he would have finished the remainder of his life feeling alone

and punished.

My past experiences had all been in the medical field. In these settings if

something was restricted we would simply take it away from the patient or not allow

it in the building. Our charge would not be permitted to buy cigarettes or to go

outside unaccompanied. This was not the way of the recovery model. This drastic

change sometimes seemed more than I could handle. At first I was enamored by the

recovery model. For so many years these residents had been told what to eat,
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where they could go and when they were allowed to leave. They were held as

captives to the system. Moving into the recovery model, they were given the

freedom to choose what they wanted in all those respects. This sudden change

made it difficult for our clients to make healthy choices on their own and not

overindulge in the things they had been unable to have.

Many spent their time buying and consuming items we would eat sparingly –

sweets, pizza, burgers, energy drinks, and other novelty items. As a staff, we were

supposed to increase our engagement and help them navigate through these

choices to come to a better understanding of healthy living; instead we often turned

a blind eye and stated, “It’s their choice.” In this we were wrong, and now it felt as

though our error had resulted in a patient’s death. For me, this situation with Harold

bordered on medical negligence. It was as though we knowingly let him cause harm

to his health and his body while we sat back and did nothing.

The residents moved through the stages of grief far slower than the staff.

While Harold was in a coma, they continued to tell each other he would pull out of

it; everything would be fine. After he went on life support, the same thing

continued, right up to the day he was taken off life support and let go of life. As

staff, we were already to the anger stage. Why had we not done more? How could

the recovery model just let people die? Had he held a knife, would we have let him

repeatedly stab himself until he bled to death? All of these questions circled

aimlessly in my mind and were posed by staff to the administrator.

Our administrator’s comments struck a chord with staff. He told us that our

goal was for each resident to be able to live independently. If we were to constantly

shield the residents from things that created harm in their lives, we would not be

giving them the opportunity to learn and experience them in a safe and managed
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environment. Without the experience of having freedom and choices, they would

not know how to deal with these things when they went back into society. While

this was a hard idea to take in, it was the absolute truth. If I told my uncle not to

smoke due to his lung disease, his addiction would still get the best of him and he

would smoke. No one would stop him from doing so, or take away his cigarettes; it is

his choice. This is known as the right to self-determination. You determine what you

do to yourself and your body.

Abstract Concepts and Generalizations:

Coming from a medical model into a recovery approach, I had to learn how to step

back and allow others to make their own choices. This was far more difficult than I

first thought it would be. No matter the decision, large or small, these individuals

had been denied that right. Everything they did was decided for them. After enough

years, they no longer believed they knew how to make choices for themselves. They

struggled with the simplest choices, ranging from whether to get a haircut to

whether they liked a particular food. This also entailed large health choices. At the

facility, we monitor what meds they need to take and whether they need to go to a

doctor, but is still primarily up to them whether or not they do this.

This experience has proven frustrating and humbling for me at the same

time. It has never been in my character not to say what I think about something. I

may want to say, “That is a horrible idea.” However, putting my judgment on

anything is not acceptable, nor is it my place to affect their learning. Instead I have

to work to help them find the positive and negative consequences of any choice

they make, and then let them decide how they want to proceed no matter whether I

think it is the right idea or not.

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Once a resident makes their choice and experiences the consequence, I learned

to work with them to evaluate and review the choice they made. This must be done

without judgment or anything similar to “I told you so.” Often shortly after the

choice is made and a result is found, it is my place to sit with a resident and ask

them how effective they felt their choice was. Did they get the outcome they

wanted? Did it cause them harm or interfere with one of their long term hopes and

dreams? Then I talk with them about other choices they might make in the future.

In spite of these conversations, the resident may continue to make unhealthy

choices. This was the case with Harold.

Through this experience I learned the power of hope. Hope is a tender thing and

it does not take much to be extinguished. After the first hospitalization, this beaten

man came back to the facility with a can-do attitude. He stood fast to the doctor’s

orders and made changes with his lifestyle. Despite his efforts, his health continued

to fail and his condition continued to worsen. At this point he believed that his effort

would not matter anyway; he lost hope. This marked a drastic change in his

condition, and his mood greatly affected the choices he made. There is nothing as

powerful as human will.

Though I had been around death before, this was one of my first experiences

dealing with the death of someone close to me. In this residential setting, the bonds

I form with clients are very strong and I become invested in their success. In this

situation I learned to deal with the death of patient, while supporting his peers

through their time of grief. All of the men in our facility have lived together and

around each other for very long periods of time while at the Oregon State Hospital,

and they have been family to each other. For some residents, this loss was harder

than it was for others. I had to access the needs of each individual separately and
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decide how best to support them. One of the most difficult things I faced was talking

with those peers who did not get along well with Harold. It was hard for me to think

they did not grieve at all while I was still upset. Some were even glad that he had

passed away and that was even harder.

The trauma of this experience brought with it many realizations. I learned the

importance of separating my personal feelings from my professional behavior. Just

because some residents had not been friends with the deceased did not mean I

could choose not to support them in their recovery or continuing needs. I could not

let my feelings of grief get in the way of being productive at work; I also had to

consider this in relation to my home life.

When Harold first passed, I was devastated and spent the whole morning crying.

I was no good at home; my children were scared and did not understand why I was

so upset. I had worked in the medical field and had patients die before, but this was

the first one I had developed a close daily relationship with. I now realize in this

career field, this is something I will have to learn to live with. People die, and

people move on to other facilities. While they say the first time is always the

hardest, I imagine that every passing will be difficult. I have learned this is to be

expected, and I will have to leave work at work for the sake and sanity of myself

and my family. It is normal to grieve for someone I am close to, but in the health

care profession, I can’t let it take over my thoughts and govern my actions.

The most important lesson I took from this experience was that everyone has the

right to choose how they live their lives. Whether I view it as right or wrong does

not matter; it is their choice. There are so many days when I want to treat them like

children. But they are not children; they are grown men and should be treated as
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such. Each of these lessons has had a huge impact and implication at work as well

as in other areas of my life, and has engrained valuable skills in me that I will carry

moving forward.

Applying Concepts in New Situations:

This situation has enabled me to be able to step back and look at the death

process. As a care provider I had to observe and record Harold’s deterioration and

the choices that he had made to get there. This skill has enabled me to look at my

own life and the lives of those around me with a more critical eye. I am able to slow

down the process and see cause and affect relationships. Now I can look at the

actions I take and the harm they may be causing me and those around me.

Being forced to evaluate choices with others has given me the tools to evaluate

choices I make in my own life. While I may still be impulsive in my choices, it is not

as frequent now. Prior to making a choice, I have begun to investigate farther by

thinking about the possible outcomes and the consequences of the choice. This has

helped me in my finances, as well as jobs, family functions, and how I interact with

my kids.

For large choices I have begun to use the same step system that I have been

taught to employ at work. A problem is written down as well as three possible

choices to correct the problem or continue with the way things are. Each choice is

then given three possible outcomes. Once that is established and reviewed, one can

make a logical decision based on the available information. More than anything, this

is done to slow down the decision making process. Often in life we make rash

decisions, (I know I do), and this process slows things down enough to make a

rational decision that is not colored by emotion.

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I have had my first real experience with death and loss as well. Being aware of

how I handled the process with Harold gave me insight as to how I may handle loss

in the future and what I could expect with a more personal loss. It has given me the

opportunity to realize that I must develop my coping skills in order to be able to

keep a steady home and work life. If I am unable to do this, I have to realize that

grief is okay and allow myself time from work and life stressors to go through the

process with as little damage to others as possible. I have also come to realize that

the grieving process is different for everyone. Some people go through all the steps,

others may just experience one or two steps, and some may choose to avoid it all

together. I should not look at these people differently just because they do not

grieve like I do, or like I think they should. Being cognizant of others and their

feelings is the key to supporting them in whatever process they must go through.

I have always been what others would consider an emotional person. It has long

been said of me that I “wear my heart on my sleeve.” Working in medical care and

directly with clients has proven to be a difficult experience. I often find myself

taking things personally and taking responsibility for the faults or errors of others. I

have come to realize that I cannot fix everything, nor should I try. A sad truth is that

no matter how we may try, as professionals we may not always be able to help a

person who is not seeking help. I can’t force someone into treatment if they do not

believe they have a problem. Understanding that people have a free will and a right

to live as they choose has made me far more tolerant in my home life with family

and friends. While I may disagree with something they do, it is their life to live and

not mine. The consequences of their actions belong to them. Realizing this has

enabled me to let go and not dwell so much on the lives of others and what I believe
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they are doing wrong. The benefit to this has been more time to focus on the wants

and needs of my family and doing what I believe is best for us as a unit.

It has done wonders for my personality to realize that I am not always right, or

even right a majority of the time. Each person feels and experiences life differently.

Those feelings and experiences will affect the choices they make, and no matter

how hard I may try, I will never fully understand what that person is going through.

In Harold’s case, he had never had freedom. He was sick of being viewed as child,

unable to care for himself. This left him feeling like less of a man – imprisoned and

put down. Knowing this makes it easier for me to understand why he would rebel

against the system.

Seeing death and the slow deterioration of a human life has also let me see how

precious and fleeting our time can be. This enabled me to reassess my values, how I

spend my time and treat those around me. I make sure to tell people I love them

frequently and work to resolve problems before they become resentments. In Harold

I witnessed something I had yet to see, the effects of hope lost.

This has had a dramatic impact on how I view things in my own life. When I get

to a point where I feel I am in over my head and there is no way out, I remember

that once I lose hope, I have lost the battle. After this reflection I tend to approach

the subject with a renewed determination and often come out successful. Instilling

this can-do attitude, and sense of intrinsic motivation, in my children has now

become a primary goal for me in my daily interactions.

While all of this was hard to handle at first, I am able to look back now on it and

see the value in his death. I gained valuable experience and a real life lesson from

things I had only read about in textbooks. It has also given me several character
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lessons about what it means to love without judgment or expectation, and to have

faith not only in myself, but in others as well.